Beth Rittenhouse

Timely utilization reviews of acute care patients for multiple facilities.

Refer cases to physician advisor when appropriate.

Review denials and forward to physician advisor when appropriate for peer to peer reviews.

Use MCG for all inpatient reviews.

Ensure patients are in the correct status.

Utilization management and discharge planning
of 140 bed hospital.
Review criteria for admission status using MCG
criteria.
Coordinate with interdisciplinary team to identify
client needs for post acute level of care.
Complete initial assessments of patients and
family to determine and address individual home
care needs.

Utilization management of 170 bed hospital
Review cases for admission status using Interqual
criteria.
Refer cases to the medical director for review
when appropriate.
Communicate clinical information to all payors
Follow up with insurance companies for
authorization and days approved.

Process denial reviews.

Case Management in a variety of departments: Keystone 65 Managed Medicare responsible for precertification of skilled nursing and ancillary services.

Concurrent review for all products where I was responsible for timely reviews of patient's within facilities in the region and used InterQual for appropriateness of admission and ongoing stays.

Precertification of DME and specialized equipment.

In all roles cases needed to be referred to a Medical director if the criteria was not met.

Responsible for direct patient care

Work closely with physicians and physical

therapists to assist patient through the continuum of pre and post operative care